Associations between Post-Discharge Care and Cognitive Impairment-Related Hospital Readmissions for Ketoacidosis and Severe Hypoglycemia in Adults with Diabetes

Background

Severe hypoglycemia (SH) or diabetic ketoacidosis (DKA) experienced high hospital readmission after being discharged. Cognitive impairment (CI) may further increase the risk, especially those experiencing medical care interruption after discharge. This study examined effect modification role of post-discharge care (PDC) on CI-associated readmission risk among US adults with diabetes initially admitted for DKA or SH.

Methods

We used the Nationwide Readmissions Database (NRD) (2016-2018) to identify individuals hospitalized with a diagnosis of DKA or SH. 30-day all-cause readmission risk was compared between those with and without CI identified during the initial hospitalization using a multivariate Cox regression. We assessed the CI-associated readmission risk in the situation with and without PDC, an effect modifier with the CI status.

Results

23,775 SH patients (53.3% female, mean age 65.9 ± 15.3) and 140,490 DKA patients (45.8% female, mean age 40.3 ± 15.4) were identified. 2,675 (11.2%) and 1,261 (0.9%) had CI during their index hospitalization.

For SH and DKA patients discharged without PDC, CI was associated with a 23% higher readmission risk (adjusted hazard ratio (aHR) =1.23, 95%CI 1.08-1.40) and a 35% higher readmission risk (aHR=1.35, 95%CI 1.08-1.70) respectively. However, when patients were discharged with PDC, we found PDC as an effect modifier to mitigate CI-associated readmission risk for both SH and DKA patients (all p-values < 0.05).

Conclusions

Our results suggest that PDC can potentially mitigate the excessive readmission risk associated with CI, emphasizing the importance of post-discharge continuity of care for medically complex patients with co-morbid diabetes and CI.